Different Biologic Grafts for Diaphragmatic Crura Reinforcement during Laparoscopic Repair of Large Hiatal Hernia: A 6-Year Single Surgeon Experience

Minimally invasive approach in the repair of hiatal hernias became a standard of care during the last two decades. Laparoscopy offers faster recovery, shorter hospital stay and less morbidity than traditional laparotomy.

Several studies have shown higher recurrence rates after a suture-based repair of hiatal hernias. A “tension-free” repair with prosthetic mesh allowed to decreased recurrence, but the use of synthetic materials produced potentially serious problems, such as erosion and dysphagia.

Multiple reports showed reduction in short-term recurrence rate after hiatal hernia repair with biologic grafts. However, the improvement in hiatal hernia recurrence decreased at long-term follow-up

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Life-threatening Capillary Leak Syndrome in an Adult with Refractory Acute Myeloid Leukemia during Allogeneic Transplantation

CLS is one of the life-threatening early complications which usually occur during hematopoietic stem cell infusion or hematopoietic reconstruction process in addition to graft-versus-host-disease (GVHD) and infection.

It is characterized by unexplained episodic capillary hyperpermeability, which causes the shift of fluid and protein from the intravascular space to the interstitial space. However, since the nonspecific signs and symptoms of CLS and the overlapping manifestations of early complications after transplantation, CLS tends to be easily confused with other early complications for clinicians.

In this case, we report an adult with refractory acute myeloid leukemia who developed fatal CLS during allo-HSCT with review of the literature.

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Liver Transplantation From Donor With Situs Inversus Totalis

A 32-year-old male had a severe traffic accident and was diagnosed with brain death 3 days after the admission. The potential donor has filled criteria for multiple organ donation and the family accepted the donation.

During organs harvesting, it was found that liver, kidneys, pancreas, stomach and all others organs of the abdominal and thoracic cavities were located in changed positions as if it were a mirror image, diagnosing the donor with situs inversus totalis.

The liver and the kidneys were flushed with standard preservation solution and procured using standard techniques. During routine backbench preparation of the liver graft, we identify the anatomical relations: common bile duct in the left side, liver artery locating in right, and portal vein behind it.

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The Association between Venous Thromboembolism and Lipid Profile in a Tunisian Population

Venous Thromboembolism (VTE) is the union of deep vein thrombosis (DVT) and pulmonary embolism (PE); it’s an important cause of morbidity and mortality with an estimated annual incidence of 0.67 to 1.0 per 1000 among the general population in western countries.

It is a polygenic disease with pathogenic contributions from both genetic and environmental risk factors; according to Virchow’s triad, VTE results from stasis hypercoagulability and the alteration in the blood vessel wall.

This dichotomy has been challenged in recent years, it still many unknown risk factors. Lipids and lipoproteins modulate the expression and/or the function of thrombotic, fibrinolytic and rheological factors among patients with cardiovascular disease.

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AN UNIQUE MAGNETIC ATTACHMENT RETAINING SILICONE NOSE PROSTHESIS

The face being the most noticeable part of the body when disfigured may lead to an impaired social life stemming from esthetic problems. Among facial defects, nasal defects produce severe cosmetic impairment.

Rehabilitation of such defects subsequent to surgery is done in a sequential manner, which includes a surgical, provisional, and definitive prosthesis. Prosthesis helps restore the patients' selfesteem and confidence, hence affecting the patients and their life style.

Adenoid cystic carcinoma (ACC) is a rare malignant perineural tumour of the major and minor salivary glands, accounting for 2% of all head and neck malignancies and approximately 10% of all salivary gland neoplasms.

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Infra Mammary Approach for Major Duct Excision in the Management of Multiple Duct Ectasia

In some cases, non-lactating women can experience nipple discharge that can be highly distressing. Such discharge is commonly caused by mammary ductal ectasia (MDE).Factors that can lead to mammary duct ectasia are still undefined.

However, possible causes of MDE can include congenital abnormalities of the ductal system, autoimmune reactions, trauma or infections.The pathogenesis of duct ectasia includes the dilatation of one or more of the large lactiferous ducts that are filled with a stagnant secretion.

These fluids trigger an irritation reaction in the surrounding tissues causing periductal mastitis or abscess and fistula formation. In some instances, a chronic indurated mass formation can take place underneath the areola that may resemble a carcinoma.

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PTEN and ERG Molecular Networks in Prostate Cancer

Prostate cancer (PCa) represents a common malignancy among elder males and one of the leading causes of cancer mortality. It may present with a variety of clinical behavior, including tumors of very low clinical significance but also highly aggressive tumors with increased risk of relapse after initial treatment.

Nowadays, many tumors traditionally treated either by radical prostatectomy or by external beam radiation therapy are considered of low clinical significance and such patients are placed under active surveillance protocols with purpose to reduce overtreatment.

As a result, in the “active surveillance” era, there is a need of establishing strong prognostic markers identifying aggressive tumors as well as clinical significant tumors even among these initially characterized of low or intermediate risk.

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Genitourinary Hydatid Disease

The most important parasitic diseases involving the genitourinary system in humans are helminthic, where schistosomiasis is the commonest followed by hydatid disease (HD) and filariasis. HD is a parasitic infestation, caused by tape worms of the genus Echinococcus, that usually involves the liver and lungs, although no organ is spared.

The varied presentations and complications of HD present routine surgical problems in endemic areas, although HD of the urinary tract is uncommon, comprising 2–4% of all cases. This article reviews the epidemiology, etiopathogenesis, clinical features and presentations, medical and surgical treatment of genitourinary and pelvic echinococcosis with special reference to individual organs.

In addition our own experience at our hospital in the last 4 years that we treated 4 cases of hydatid cysts of which 3 were renal HD and one was primary pelvic HD.

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Isolated Free Fluid without Pneumoperitoneum on Computed Tomography in Blunt Abdominal Trauma

Non-operative management for blunt abdominal trauma (BAT) is considered the treatment of choice for patients with stable hemodynamic status. Due to the high efficiency and accuracy of abdominal computed tomography (CT) in the identification of solid organ injury, it is increasingly utilized for stable patients sustaining BAT.

However, the diagnosis of hollow viscus or diaphragmatic injury remains difficult. The diagnostic signs of bowel perforation are oral contrast extravasation and pneumoperitoneum; however, both diagnostic signs in the case of bowel injury have high specificity, but low sensitivity.

Other suggested signs of bowel injury, including bowel wall thickening, streaking of the mesentery, dilated bowel loops, and free fluid without solid organ injury, were unreliable.

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Advances in Targeted Re-innervation

In recent years there have been numerous advances in the field of prosthetics. Targeted reinnervation is a newly developed surgical procedure used to improve the motor control and sensation of the affected limb.

In this procedure, the residual nerves from the amputated extremity are identified and transferred to new “targets” that have otherwise lost their function. These newly innervated muscles and targets are then used as amplifiers for the amputated nerves in order to restore the functional loss.

Use of these newly innervated muscles or at times even only parts of muscles (two heads of pectoralis after a forequarter amputation) would allow a more innate control of the bio-prosthetics.This will not only allow the new muscle contractions to be sensed and used to control prosthesis, it will also enable the overlying skin to have protective sensation.

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Giant Condyloma Acuminatum (Buschke-Lowenstein Tumor)

Surgery, Condyloma acuminata is the most common sexually transmitted disease found in young, sexually active population and mostly seen in the colorectal practice.

Condylomas have been well known in history with physicians of ancient Roman Empire calling them as “figs” which were thought to result from excessive sexual exploits. The term “acuminatum” means “pointed” and was used to distinguish condyloma acuminatum from condyloma lata, the “broad” condyloma of syphilis.

Giant condyloma acuminatum or Condylomata gigantea (commonly known as Buschke-Lowenstein tumor) is a rare, aggressive, slow growing; fungating variant of condyloma that is usually found in the genital and perianal regions but may affect any portion of the anogenital region.

A Short Communication on the Need for Interdisciplinary Action with Families with Deaf Children Who Use Bilateral Cochlear Implants

Bilateral Cochlear Implantation (BCI), both simultaneous and short interval sequenced, is a widely advantageous and valuable resource with respect to unilateral cochlear implantation and long interval bilateral sequenced cochlear implantation,  generating new concerns for families with deaf children.

Lammers et al.Recently found more statistically significant results regarding the perception of sound and the expressive linguistic development of children with Simultaneous Cochlear Implantation (SCI) compared to those with sequential bilateral cochlear implantation after 1 year of hearing experience with the devices.

Moreover, the available data show that there is no proliferation in the risks associated to SCI, assuming that only one surgical, hospital episode was recorded.In this sense, relevant advances over BCI in deaf children are evident. Nevertheless, efficiency and development of bilateral cochlear implants’ performance should not be taken for a grant. Not only clinical area influences a correct usage of cochlear implants.

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PTEN and ERG Molecular Networks in Prostate Cancer

Prostate cancer (PCa) represents a common malignancy among elder males and one of the leading causes of cancer mortality. It may present with a variety of clinical behavior, including tumors of very low clinical significance but also highly aggressive tumors with increased risk of relapse after initial treatment.

Nowadays, many tumors traditionally treated either by radical prostatectomy or by external beam radiation therapy are considered of low clinical significance and such patients are placed under active surveillance protocols with purpose to reduce overtreatment.

As a result, in the “active surveillance” era, there is a need of establishing strong prognostic markers identifying aggressive tumors as well as clinical significant tumors even among these initially characterized of low or intermediate risk.

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Liver Transplantation for Hepatocellular Carcinoma: A Time to Push Forward

Despite improvements in therapeutic modalities over the past decade hepatocellular carcinoma (HCC) remains the second leading cause of cancer related deaths accounting for approximately 700,000 deaths worldwide each year.

HCC is frequently multifocal and arises in setting of cirrhosis (>80%), hence surgical resection of HCC with curative intent is only feasible in 20-30% of patients at time of diagnosis. We have known for years that liver transplantation (LT) is the gold standard for HCC therapy in the setting of significant liver disease given its oncologic advantage of replacing the organ harboring malignancy all while reversing the physiologic liver dysfunction.

In 1996 Mazzafero et al. demonstrated that by limiting LT to HCC patients with a single tumor of ≤ 5 cm, or up to 3 tumor nodules ≤ 3 cm, excellent outcomes could be achieved giving rise to the influential Milan Criteria.

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The Effectiveness of Polypropylene Mesh in the Open and Laparoscopic Repair of Divarication of the Recti

Divarication of the recti (Diastasis recti) is the separation of the rectus abdominis muscle into right and left halves (a gap of roughly 2.7 cm or greater), usually due to thinning and stretching of the linea alba resulting from various reasons.

Typically, the two sides of the muscle are joined at the linea alba at the body midline. Divarication of the recti would appear as a long ridge extending down the abdominal midline from the xiphoid process to the umbilicus. It will become more prominent with straining and may disappear when the abdominal muscles are relaxed.

It is reported to be more common in multiparous women (about 66%) due to the repeated episodes of stretching [1,2].The most common reported etiologic factors include chronic or intermittent abdominal distension, advancing age, or familial weakness of the abdominal musculofascial tissues.

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